Jennie Kyle bonds with her newborn baby Aron in the maternity ward at St. Paul's Hospital.Jason Payne
/ PNG

To grasp the scope of what St. Paul's Hospital accomplishes in a single day, we spent 24 consecutive hours there, working in shifts with three teams of one reporter and one photographer. Read on and flip through the photo gallery to learn what they saw…

3:05 a.m. In the maternity ward, Kitsilano couple Alexis Mickle and Matt Ploughman believe they are in the final stretch.

Alexis is experiencing contractions every three to four minutes, and the expectant first-time mother is learning about the pain involved in labour.

“The contractions hurt way more than I thought they would,” Alexis says, as nurse Erika Monk monitors her breathing. “Before, I thought absolutely no drugs, no epidural. But I leaped at the chance of having morphine.”

“Yeah, she was pretty adamant,” her partner Matt Ploughman says.

Matt rubs her lower back as she struggles with the pain. “You got it. Keep breathing,” he says.

As the contractions ease off, he steps outside for a break. Alexis is six days overdue, and Matt hasn’t slept in more than 24 hours.

“There was this calm before the storm,” he says, “but now the anticipation is building up. Now, it’s coming. I’m probably gonna break down, and cry. I’ll be joyful. I can’t wait.”

Meanwhile, in the room Alexis is confiding to her sister Cheyenne that she’s running out of strength, mentally and physically.

“I don’t think I can do this anymore,” she moans. “I’m falling asleep and feeling the pains. It wakes you up so bad.”

Soon after, Alexis is administered an epidural, and she rests calmly through the early morning.

They walk around the horseshoe-shaped acute-bed room, pausing at each stall. One patient has been moved to the renal unit, and a second has had a CT scan completed after suffering a headache for five days. An elderly woman will be moved to fast-track treatment, suffering severe constipation. An elderly man, described as a chronic alcoholic, needs “repeat blood work.”

Eventually, on the overnight shift — from 7 p.m. Thursday to 7 a.m. Friday — 74 patients will come through the emergency department, with 62 treated and discharged and 12 admitted to other units in St. Paul’s.

“It was a moderate volume night,” Dr. Kalla says. “Just not high acuity.”

5:00 a.m. Most of the hospital is asleep, but a few steps past the triage area Downtown Eastside resident Michael Kanouse, 52, is having a lively conversation with respiratory technician Nicole Burgher.

Kanouse is speaking while he breathes into a clear face-mask which is hooked up to an apparatus called a Ventolin nebulizer. The machine helps him to breathe by loosening material in his lungs.

“When I really cough hard and my knees shake and I see stars, I spit up and it’s clear with a white ball in the middle,” Kanouse tells Burgher. “I’ve been panicking, because it’s hard to breathe lately.”

Animated and affable throughout his 30-minute session, Kanouse says his breathing troubles are caused by asbestos in his lungs from his days working as a drywall installer.

Elaine Woodhall, 66, says except for cramping in her right hip, she feels great after sleeping through most of her eight-hour blood-cleansing session.

One of the first patients to join St. Paul’s nocturnal program, her improved health is a testament to its effectiveness. She went from multiple four-hour day sessions every week, to just three eight-hour night sessions per week.

“It’s a huge difference, because the four hours of treatment is just terrible for her,” nurse Jeanette Feizi Farivar says. “Her breathing is much improved.”

“When your kidneys aren’t functioning it doesn’t take all the toxins out of your system, and they can go into your heart and kill you,” Woodhall says. “Now, I don’t have to take my insulin anymore. I don’t take heart pills anymore, or blood pressure pills.”

6:15 a.m. Downstairs in the ED, Dr. Joe Finkler talks about what makes St. Paul’s unique among the Lower Mainland hospitals he has worked at. By far, the population treated at St. Paul’s presents the most complex cluster of treatment challenges.

Finkler quickly sketches a number of interlocking circles. In the middle circle he scribbles the word “medical,” and in the surrounding circles, “mental illness,” “drug/alcohol” and “psychiatric.”

For an emergency physician at St. Paul’s, intake and diagnosis is not straightforward. Often there is the story told by a patient, Finkler says, and the more complete story told by their medical records and postal code.

“I’m a bit like a cop,” Finkler says. “I look at where people live, and I look at their pharma-scan information.”

For this shift, Finkler believes the most ill patient he will treat is in Acute Bed 16. She’s a frequent visitor: a woman from near the Downtown Eastside’s Cobalt Hotel who is suffering a fever, is HIV-positive and is vomiting. She is in septic shock — suffering from a severe infection.

“We get them a bed quickly and hunt for the source of infection and hit it with antibiotics,” Finkler says.

Doctors in the St. Paul’s ED have plenty of opportunity to think philosophically about how patient care could be improved, and where public money could be spent to staunch the health problems that ravage the Downtown Eastside. Doctors are amazed at the resiliency of “frequent flyer” patients who constantly “abuse themselves with drugs and alcohol and live in Third World conditions,” Finkler says. But they are beyond judging. There is really no treatment that could magically turn these people’s lives around, according to Finkler’s years of experience.

“If you take a lot of these women with chronic issues, you will find most of them were raped or abused when they were young,” he says. “I guarantee you, most of them didn’t have much under the Christmas tree.”

6:55 a.m. Upstairs in maternity, there is evidence of the type of love that likely was missing for the woman in Acute Bed 16.

Michael Kyle of Whistler rolls out of a sleeping bag in his reclining armchair and opens a curtain, letting morning sun into the room. After a C-section delivery at 8:28 a.m. the day before, and a peaceful night of rest, his wife, Jennie, holds their newborn son, Aron.

“He’s a mellow baby,” Jennie says, as Michael looks down at the pair with a proud smile.

Hours later in a room down the hallway, Alexis Mickle and Matt Ploughman would welcome their first baby, a girl, into the world.

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